Work-related Traumatic Brain Injury

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1 Professor of OS & OT, University of Toronto Saunderson Family Chair in ABI Research, Toronto Rehabilitation Institute Work-related Traumatic Brain Injury Angela Colantonio, PhD, OT Reg. (Ont)

2 Improvement of Quality of Life of Adults with Acquired Brain Injury (ABI) ABI in the Population Collaborative Links: - Local - Provincial - National - International Intervention Studies Aging with TBI Providers Consumers / Caregivers Trainees, staff Gender Issues Knowledge Transfer

3 Definition of TBI An alteration in brain function, or other evidence of brain pathology, caused by an external force Brain Injury Association of America

4 Acquired Brain Injury TRAUMATIC Open Closed NON-TRAUMATIC Anoxia Aneurysms Brain Tumors Encephalitis Meningitis Metabolic Encephalopathy Stroke with Cognitive Disabilities

5 Traumatic Brain Injury More common than breast cancer, spinal cord injury, HIV / Aids and multiple sclerosis combined

6 Traumatic Brain Injury Statistics International Brain Injury Association: Leading cause of death and disability for persons under age 50. Injuries to the brain are among the most likely to result in death and permanent disability. Canadian Institute for Health Information: Direct costs million

7 Consequences of TBI Cognition: concentration, memory, judgment, communication. Movement abilities: strength, coordination, balance. Sensation: tactile sensation, special senses such as vision. Emotion: instability, impulsivity, mood Work: can lead to profound disruption in lives of workers.

8 TBI and Employment Associated with lost wages, unemployment and disability. Traumatic brain injury represents a large number of serious or fatally injured workers. Approx. half of all Canadian workplace fatalities involve a brain injury (Tricco et al., 2006). Work related TBIs in Ontario are

9 Work Related TBI Rationale Wide range of study on various aspects of severe and fatal WrTBI, but a paucity of research that includes all levels of severity WrTBI can lead to some of the longest layoffs and highest claim costs, and rehabilitation of victims has proven to be difficult. WrTBI is an often overlooked occupational health issue.

10 Examining Occupational Traumatic Brain Injury in Ontario A. Colantonio, D. Mroczek, J. Patel, J.Lewko, J. Fergenbaum, R. Brison (2010) Funded by the Ontario Neurotrauma Foundation

11 Work Related TBI Aim To examine factors associated with WrTBI that can assist stakeholder organizations with better prevention and treatment of WrTBI. To examine WrTBI outcomes across all severity levels. To examine factors and likelihoods associated with different mechanisms of injury, industry sectors, severity of injury, and economic burden with regard to claim costs. To present these findings to, and work with those organizations and individuals that can assist with prevention of WrTBI (Colantonio et al., 2010).

12 Work Related TBI Method Over 1500 Ontario WSIB claims that were internally coded by the WSIB as either intracranial injury or concussion examined eligible, exclusions due to miscoding or insufficient medical information. Data abstraction and analysis.

13 Work Related TBI Variables Measured Demographic Age Gender Occupation Injury Mechanism of injury Part(s) of body injured Severity of injury Claim and health care costs Lost time from work

14 Limitations of Data WSIB covers only 70% of workforce. Head codes only, Multiple codes not examined.

15 Work Related TBI RESULTS

16 WrTBI and Gender Gender Male Female 42% 58% Significantly higher percentage of females when compared to studies focusing on more serious injuries.

17 Percent WrTBI and Gender Percentage of Male and Female Workers by Age Groups Opposite trends in age groupings - younger males and older females. p-value = < >=45 Age Groups Male Female

18 WrTBI and Age

19 WrTBI and Age Mechanism of Injury % Struck By/Against most common injury type. Older workers most likely to be injured in a fall Struck and Fall Struck by/against Fall Others Younger workers more likely to be injured by Struck By/Against. p <0.001

20 Percent WrTBI and Age Time of Injury :00-05:59 06:00-08:59 09:00-11:59 13:00-14:59 15:00-17:59 18:00-23:59 All age groups most likely to be injured during the morning hours. Older workers suffering the most afternoon injuries. Time < >=45

21 # of Injuries WrTBI by Month of Injury Months

22 Mechanism of Injury Most common injury types: Struck By/Against and Falls. Marginal but alarming subsets: Motor Vehicle Crashes and Assaults.

23 Percent Mechanism of Injury By Season Spring Summer Autumn Winter Seasons Struck by/against Struck and Fall Fall from Falls considerably more likely to occur in winter. P-value <

24 Factors Associated With Over 2 Months Lost Time Older age Speak French or languages other than English Work in construction industry Paid by commission / piecework

25 Factors Associated With Higher Total Costs Older age Male Work in construction industry Paid by commission / piecework Injury to multiple parts of body Injured in a fall

26 Risk Factors for WrTBI Men Working full time in construction, primary industry, trades and transport. Younger. More likely to be struck by or against object. Likely to be more seriously injured. Incur higher claim costs and longer layoffs.

27 Risk Factors for WrTBI Women Working in government services, business and finance, sales and service. Older. More likely to be injured in a fall. Higher skill level overall than that of men. Likely to be injured in winter. Less seriously injured. Incur lower claim costs and shorter layoffs.

28 Risk Factors for WrTBI Recurring Trends Recurring trends that may be insignificant statistically, but are nonetheless noteworthy: Home care / long term nurses, police officers, and teachers being assaulted. Home care nurses, drivers and letter carriers slipping on icy terrain. Office workers and machine operators striking their head against workstation/machine. Tradesmen and general labourers falling form scaffolds, ladders and truck beds. Younger workers being involved in motor vehicle crashes.

29 WrTBI In Construction Colantonio et al., 2009

30 WrTBI In Construction Rationale Aim Work related brain injuries in construction sector lead to some of the highest claim costs and longest layoffs due to injury. Wide range of study on WrTBI, but none focusing on the construction industry in Canada. To provide a more in-depth examination of WrTBI in the construction industry across all levels of injury severity.

31 WrTBI In Construction Method WSIB claim files from examined. Focus only on TBI claims from one of WSIB s construction rate groups. Descriptive, bivariate, and multivariate analyses performed.

32 WrTBI In Construction RESULTS

33 # of TBIs WrTBI In Construction TBI by month in construction Month Most injuries occurring in the summer months. Second peak in October, possibly due to pressure to complete jobs before the difficult winter months.

34 # of TBIs WrTBI In Construction TBI by Day time Working Hours :00-9:59 10:00-10:59 11:00-11:59 12:00-12:59 13:00-13:59 14:00-14:59 15:00-15:59 16:00-16:59 17:00-17:59 Hours TBI most likely to occur in the morning. Second peak in the late afternoon.

35 WrTBI In Construction Mechanism of injury by age group in construction Fall Struck by, agains t # of TBIs Younger workers more likely to be struck by/against object. Older workers more likely to be injured in a fall.

36 WrTBI In Construction Job Type Most helpers / labourers younger. Other types more experienced tradesmen.

37 WrTBI In Construction Those under 45 years of age significantly more likely to be injured in the morning. Those over 45 years old exhibit similar risk throughout the day, with a mild peak in the late afternoon.

38 WrTBI In Construction Risk Factors Early in work week. Morning hours. Summer months and October. Older Workers Fall type injuries. Experienced tradesmen. Younger Workers Struck by / against injuries. Trades helpers and labourers.

39 Conclusion Rates of WrTBI in Ontario have doubled from 1996 to 2004 according to WSIB numbers. WrTBI is one of the most the most costly and damaging injury types. Strong age and gender related patterns. Risk factors identified for various industry sectors and job types. Grand scope for prevention of WrTBI.

40 Future Endeavors Transfer findings to stakeholder organizations in order to better prevent injuries. Identify and examine other aspects of WrTBI in order to assist with and build upon current research.

41 Future Directions Please assist us by posing any questions or making any comments you might have. What prevention strategies should be employed? What areas of WrTBI should be explored in the future? Which practical solutions can be drawn? How does this research harmonize with your goals as a stakeholder organization? What kind of work can be done to achieve the greatest tangible results?

42 Mild to Moderate Work-related Traumatic Brain Injury: A Pilot Study Colantonio A, Vernich L, Salehi S, Carter A, Vartanian O, Bayley M, Kirsh B, Hebert D, Lewko J, Kristman V, Cassidy D, Garritano E, Boucher P, Kubrak O, Mantis S University of Toronto, Toronto Rehabilitation Institute-UHN (TRI), DRDC Toronto, Laurentian University, Lakehead University, Toronto Western-UHN, Infrastructure Health & Safety Association, Public Services, Health & Safety Association, Ontario Network of Injured Workers Group

43 Research Question What are the individual, social and environmental factors associated with successful return to work for persons who have sustained a Work-related Traumatic Brain Injury (WrTBI)?

44 Methods Retrospective cohort design/ telephone interview Participants were recruited from a consecutive non-random sample of individuals who: Had sustained a mild to moderate WrTBI. Were referred to the Neurology Services specialty clinic at TRI by the Ontario WSIB. Underwent a comprehensive assessment by the Neurology Assessment team and were discharged between

45 Most Common Perceived Factors that Facilitated RTW (unpublished preliminary results) For RTW Only (n=25) % Yes Support of Family/Friends 92 Support of Treatment Providers 80 Job Modifications/Employer Accommodation/Gradual Return (modified hours) Medications 72 Partial Recovery from Injury 72 Support of Co-workers 68 Workplace Commitment to Health and Safety 64 Support of TRI Neurology Team 56 Early Contact from Employer 48 Access to RTW Planners/Coordination 44 Supervisor Trained in RTW Planning 44 76

46 Barriers for RTW/Reasons for Not Returning to Work Combined (n=51): % Difficulty thinking and concentrating 92 Fatigue/reduced tolerance and endurance 92 Pain 84 Headaches 83 Sleep Disturbance 81 Dizziness or balance problems 79 Emotional/psychological issues 73 Weakness 71 Physical impairment 65 Job is too physically demanding 63 Ability to communicate 50 Weight gain 42 Unsupportive employer 37 Transportation difficulties 31 Job has changed or no longer exists 25 Unsupportive coworkers 19

47 Discussion Findings suggest that after mild to moderate TBI, RTW may be facilitated through the use of job modifications, effective communication with employers, and any strategies that may positively impact on the TBI survivors' emotional well-being, and cognitive abilities.

48 Next Steps More research on accommodations for persons with cognitive disability Larger scale study across sectors Intervention studies/innovations using technologies?

49 Contact: American Congress of Rehabilitation Medicine International Task Force on Girls and Women with ABI OR Girls and Women with TBI blog

50

51 Research Informed Theatre Based on focus groups with consumers, family members and health care providers AFTER THE CRASH, performed by the Ruckus Ensemble:

52 idapt: Innovative Technology for People in Challenging Environments Geoff Fernie, PI.

53 Thank You Thanks to everyone for attending! The findings of this study do not reflect the reviews of the Toronto Rehabilitation Institute or the Workers Safety and Insurance Board

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